Healthcare Provider Details

I. General information

NPI: 1881508273
Provider Name (Legal Business Name): KATHLEEN ERIN PARKER LSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NW CROSBY DR
BEND OR
97703-7298
US

IV. Provider business mailing address

61462 LITTLE JOHN LN
BEND OR
97702-2206
US

V. Phone/Fax

Practice location:
  • Phone: 503-349-0641
  • Fax:
Mailing address:
  • Phone: 503-349-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number128317
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: